Novel prognostic score for immediate and late success after percutaneous mitral balloon commissurotomy in patients with mitral stenosis

Abstract: Objectives. Percutaneous mitral balloon commissurotomy (PMBC) remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis (MS) and suitable anatomy. The objective of this study was to propose a new score for the prediction of immediate and late success. Methods. This is a single-center, retrospective analysis of all 1582 patients with severe mitral stenosis who underwent PMBC from August 1987 to July 2010. The composite outcome was cardiovascular death, new PMBC, or mitral valve repair surgery up to 24 years of follow-up. Results. Mean patient age was 36.8 ± 12.9 years, most (86.4%) were female, and Wilkins score was between 9-11 in 49.1% of patients. In the multivariate analysis, the predictors of immediate success were age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P=.01), left atrium size (OR, 0.96; 95% CI, 0.93-0.99; P=.01), mean preprocedure mitral gradient (OR, 0.93; 95% CI, 0.89-0.96; P<.001), intermediate Wilkins score 9-11 (OR, 0.62; 95% CI, 0.40-0.94; P=.02), and high Wilkins score ≥12 (OR, 0.35; 95% CI, 0.16-0.76; P<.01). For prediction of late events, age (hazard ratio [HR], 0.98; 95% CI, 0.97-0.98; P<.001), New York Heart Association class III-IV (HR, 1.50; 95% CI, 1.18-1.92; P<.001), left atrium size (HR, 1.02; 95% CI, 1.02-0.04; P<.01), and high Wilkins score ≥12 (HR, 2.02; 95% CI, 1.30-3.15; P<.01) were significant. Two nomograms were developed using significant predictors from the model. Conclusions. In this large population, not only the Wilkins score, but also clinical and hemodynamic features, seem to be relevant in predicting immediate and late success for patients with rheumatic MS who underwent PMBC.

Assessment of drug-eluting stents and bioresorbable stentsby grayscale IVUS and IVUS-based imaging modalities

Abstract Grayscale IVUS and IVUS-based imagingmodalities during the last years have becomeuseful in the assessment not only of drug elutingstent, but also of new bioresorbable vascular scaffolds.Although IVUS resolution is not sufficient fordetermining stent coverage (optical coherence tomographyis the gold standard), serial IVUS can measureintimal hyperplasia, assess acute and late incompletestent apposition, detect the presence and persistenceof edge dissections, study edge effects and look forcauses of restenosis and thrombosis. In addition otherIVUS-based imaging modalities, such as IVUS-VH,iMAP or palpography, can be used to study the serialcompositional and mechanical changes of the plaquebehind stent struts and also to follow the bioresorptionof the new bioresorbable scaffolds, analyzing thebackscattering signal coming from the polymericstruts. This review details and evaluates grayscaleIVUS and IVUS-based techniques findings in clinicaltrials, highlighting the usefulness of these imagingmodalities in the study of drug eluting stents andbioresorbable vascular scaffold.